Abstract
Background
This study compared two homogeneous groups of patients submitted to either surgical resection (HR) or laparoscopic radiofrequency ablation (LRFA) for the treatment of hepatocellular carcinoma (HCC). When compatible with the liver functional reserve, HR remains the treatment of choice for HCC, while LRFA seems to be a promising, less invasive alternative. We thus compared HR or LRFA for short- and long-term outcomes in patients with a single HCC nodule and Child-Pugh class A liver cirrhosis.
Methods
We enrolled 152 cirrhotic patients out of 372 cases consecutively evaluated for HCC. Enrolled patients with similar baseline characteristics underwent HR (n = 78) or LRFA (n = 74), in both cases with intraoperative ultrasonography, and they were then followed for similar durations (mean ± standard deviation, 36.2 ± 23.5 months for HR vs. 38.2 ± 28.4 for LRFA). Outcomes included short- and long-term morbidity, HCC recurrence, and overall survival.
Results
Short-term morbidity was far higher in the HR group while, during follow-up, HCC recurrence (mainly local) was more frequent in patients treated with LRFA. More importantly, baseline alfa-fetoprotein levels and early HCC recurrence after treatment greatly influenced overall survival, while the use of HR or LRFA did not predict it. On the other hand, HCC recurrence was found to be determined by the surgical approach and ultrasound characteristics of the tumor.
Conclusions
Our data were obtained from a large number of HCC cases and support similar survival rates after HR or LRFA for single HCC nodules on Child-Pugh class A liver cirrhosis, despite a marked increase in HCC recurrence rates after LRFA.
Similar content being viewed by others
References
Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–36.
Bigourdan JM, Jaeck D, Meyer N, et al. Small hepatocellular carcinoma in Child A cirrhotic patients: hepatic resection versus transplantation. Liver Transpl. 2003;9:513–20.
Vivarelli M, Guglielmi A, Ruzzenente A, et al. Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver. Ann Surg. 2004;240:102–7.
Montorsi M, Santambrogio R, Bianchi P, et al. Survival and recurrences after hepatic resection or radiofrequency for hepatocellular carcinoma in cirrhotic patients: a multivariate analysis. J Gastrointest Surg. 2005;9:62–7.
Hong SN, Lee SY, Choi MS, et al. Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function. J Clin Gastroenterol. 2005;39:247–52.
Maluccio M, Covey AM, Gandhi R, et al. Comparison of survival rates after bland arterial embolization and ablation versus surgical resection for treating solitary hepatocellular carcinoma up to 7 cm. J Vasc Interv Radiol. 2005;16:955–61.
Chen MS, Li JQ, Zheng Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006;243:321–8.
Wakai T, Shirai Y, Suda T, et al. Long-term outcomes of hepatectomy vs percutaneous ablation for treatment of hepatocellular carcinoma < or = 4 cm. World J Gastroenterol. 2006;12:546–52.
Abu-Hilal M, Primrose JN, Casaril A, et al. Surgical resection versus radiofrequency ablation in the treatment of small unifocal hepatocellular carcinoma. J Gastrointest Surg. 2008;12:1521–6.
Yamakado K, Nakatsuka A, Takaki H, et al. Early-stage hepatocellular carcinoma: radiofrequency ablation combined with chemoembolization versus hepatectomy. Radiology. 2008;247:260–6.
Guglielmi A, Ruzzenente A, Valdegamberi A, et al. Radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma in cirrhosis. J Gastrointest Surg. 2008;12:192–8.
Montorsi M, Santambrogio R, Bianchi P, et al. Laparoscopy with laparoscopic ultrasound for pretreatment staging of hepatocellular carcinoma: a prospective study. J Gastrointest Surg. 2001;5:312–5.
Santambrogio R, Opocher E, Costa M, Cappellani A, Montorsi M. Survival and intra-hepatic recurrences after laparoscopic radiofrequency of hepatocellular carcinoma in patients with liver cirrhosis. J Surg Oncol. 2005;89:218–26.
Spina G, Santambrogio R, Opocher E, et al. Improved quality of life after distal splenorenal shunt. A prospective comparison with side-to-side portacaval shunt. Ann Surg. 1988;208:104–9.
Capussotti L, Vergara V, Polastri R, Bouzari H, Galatola G. Liver function and encephalopathy after partial vs direct side-to-side portacaval shunt: a prospective randomized clinical trial. Surgery. 2000;127:614–21.
Makuuchi M, Belghiti J, Belli G, et al. IHPBA concordant classification of primary liver cancer: working group report. J Hepatobiliary Pancreat Surg. 2003;10:26–30.
Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology. 2002;35:519–24.
Santambrogio R, Bianchi P, Pasta A, Palmisano A, Montorsi M. Ultrasound-guided interventional procedures of the liver during laparoscopy: technical considerations. Surg Endosc. 2002;16:349–54.
Makuuchi M, Hasegawa H, Yamazaki S. Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet. 1985;161:346–50.
Cook RC, Alscher KT, Hsiang YN. A debate on the value and necessity of clinical trials in surgery. Am J Surg. 2003;185:305–10.
Miyazaki M, Kimura F, Shimizu H, et al. Surgical treatment for liver cancer. Current issues. Dig Surg. 2007;24:120–5.
Poon RT. Optimal initial treatment for early hepatocellular carcinoma in patients with preserved liver function: transplantation or resection? Ann Surg Oncol. 2007;14:541–7.
Garrean S, Hering J, Saied A, Helton WS, Espat NJ. Radiofrequency ablation of primary and metastatic liver tumors: a critical review of the literature. Am J Surg. 2008;195:508–20.
Machi J, Uchida S, Sumida K, et al. Ultrasound-guided radiofrequency thermal ablation of liver tumors: percutaneous, laparoscopic, and open surgical approaches. J Gastrointest Surg. 2001;5:477–89.
Chung MH, Wood TF, Tsioulias GJ, Rose DM, Bilchik AJ. Laparoscopic radiofrequency ablation of unresectable hepatic malignancies. A phase 2 trial. Surg Endosc. 2001;15:1020–6.
Santambrogio R, Podda M, Zuin M, et al. Safety and efficacy of laparoscopic radiofrequency ablation of hepatocellular carcinoma in patients with liver cirrhosis. Surg Endosc. 2003;17:1826–32.
Regimbeau JM, Kianmanesh R, Farges O, et al. Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma. Surgery. 2002;131:311–7.
Sakon M, Nagano H, Nakamori S, et al. Intrahepatic recurrences of hepatocellular carcinoma after hepatectomy: analysis based on tumor hemodynamics. Arch Surg. 2002;137:94–9.
Sumie S, Kuromatsu R, Okuda K, et al. Microvascular invasion in patients with hepatocellular carcinoma and its predictable clinicopathological factors. Ann Surg Oncol. 2008;15:1375–82.
Kumada T, Nakano S, Takeda I, et al. Patterns of recurrence after initial treatment in patients with small hepatocellular carcinoma. Hepatology. 1997;25:87–92.
Shimada M, Hasegawa H, Gion T, et al. Risk factors of the recurrence of hepatocellular carcinoma originating from residual cancer cells after hepatectomy. Hepatogastroenterology. 1999;46:2469–75.
Adachi E, Maehara S, Tsujita E, et al. Clinicopathologic risk factors for recurrence after a curative hepatic resection for hepatocellular carcinoma. Surgery. 2002;131:S148–52.
Poon RT, Fan ST, Ng IO, et al. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer. 2000;89:500–7.
Wong LL. Current status of liver transplantation for hepatocellular cancer. Am J Surg. 2002;183:309–16.
Livraghi T, Goldberg SN, Lazzaroni S, et al. Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology. 2000;214:761–8.
Lau WY, Leung TW, Yu SC, Ho SK. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg. 2003;237:171–9.
Seidenfeld J, Korn A, Aronson N. Radiofrequency ablation of unresectable primary liver cancer. J Am Coll Surg. 2002;194:813–28.
Takayama T, Sekine T, Makuuchi M, et al. Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet. 2000;356:802–7.
Schwartz JD, Schwartz M, Mandeli J, Sung M. Neoadjuvant and adjuvant therapy for resectable hepatocellular carcinoma: review of the randomised clinical trials. Lancet Oncol. 2002;3:593–603.
Kubo S, Nishiguchi S, Hirohashi K, et al. Randomized clinical trial of long-term outcome after resection of hepatitis C virus-related hepatocellular carcinoma by postoperative interferon therapy. Br J Surg. 2002;89:418–22.
Sun HC, Tang ZY. Preventive treatments for recurrence after curative resection of hepatocellular carcinoma—a literature review of randomized control trials. World J Gastroenterol. 2003;9:635–40.
Matsuda M, Fujii H, Kono H, Matsumoto Y. Surgical treatment of recurrent hepatocellular carcinoma based on the mode of recurrence: repeat hepatic resection or ablation are good choices for patients with recurrent multicentric cancer. J Hepatobiliary Pancreat Surg. 2001;8:353–9.
Chevret S, Trinchet JC, Mathieu D, et al. A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire. J Hepatol. 1999;31:133–41.
Hanazaki K, Kajikawa S, Koide N, Adachi W, Amano J. Prognostic factors after hepatic resection for hepatocellular carcinoma with hepatitis C viral infection: univariate and multivariate analysis. Am J Gastroenterol. 2001;96:1243–50.
Matsumoto K, Yoshimoto J, Sugo H, et al. Relationship between the histological degrees of hepatitis and the postoperative recurrence of hepatocellular carcinoma in patients with hepatitis C. Hepatol Res. 2002;23:196–201.
Cha C, Fong Y, Jarnagin WR, Blumgart LH, DeMatteo RP. Predictors and patterns of recurrence after resection of hepatocellular carcinoma. J Am Coll Surg. 2003;197:753–8.
Imamura H, Matsuyama Y, Tanaka E, et al. Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol. 2003;38:200–7.
Prospective validation of the CLIP score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma. The Cancer of the Liver Italian Program (CLIP) Investigators. Hepatology. 2000;31:840–5.
Shah SA, Cleary SP, Wei AC, et al. Recurrence after liver resection for hepatocellular carcinoma: risk factors, treatment, and outcomes. Surgery. 2007;141:330–9.
Fontana RJ, Hamidullah H, Nghiem H, et al. Percutaneous radiofrequency thermal ablation of hepatocellular carcinoma: a safe and effective bridge to liver transplantation. Liver Transpl. 2002;8:1165–74.
Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology. 1999;30:1434–40.
Figueras J, Jaurrieta E, Valls C, et al. Resection or transplantation for hepatocellular carcinoma in cirrhotic patients: outcomes based on indicated treatment strategy. J Am Coll Surg. 2000;190:580–7.
Wayne JD, Lauwers GY, Ikai I, et al. Preoperative predictors of survival after resection of small hepatocellular carcinomas. Ann Surg. 2002;235:722–30.
Poon RT, Fan ST, Tsang FH, Wong J. Locoregional therapies for hepatocellular carcinoma: a critical review from the surgeon’s perspective. Ann Surg. 2002;235:466–86.
Avila MA, Berasain C, Sangro B, Prieto J. New therapies for hepatocellular carcinoma. Oncogene. 2006;25:3866–84.
Ishak K, Baptista A, Bianchi L, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995;22:696–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Santambrogio, R., Opocher, E., Zuin, M. et al. Surgical Resection Versus Laparoscopic Radiofrequency Ablation in Patients With Hepatocellular Carcinoma and Child-Pugh Class A Liver Cirrhosis. Ann Surg Oncol 16, 3289–3298 (2009). https://doi.org/10.1245/s10434-009-0678-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-009-0678-z